Extracardiac Fontan with direct cavopulmonary connections: midterm results.

OBJECTIVES

The aim of this study was to analyse the midterm results following superior and inferior direct cavopulmonary connections (DCPC) to create a Fontan circulation in patients with functionally univentricular hearts.

METHODS

A retrospective review of patients operated on between January 2005 and December 2011 was carried out.

RESULTS

Thirty consecutive patients who underwent this type of operation were retrospectively reviewed. There were 18 (60%) males and 12 (40%) females, with a median age of 69 months (range 16-150 months) and median weight of 23 kg (range 11-46 kg). Aortic cross-clamping was used in 10 patients, with a median cross-clamp time of 40 min (range 23-99) and a median cardiopulmonary bypass (CPB) time of 135 min (range 76-179 min). The remaining 20 patients were operated on without aortic cross-clamping. Their median CPB time was 104 min (range 78-139 min). Fenestration was performed in 16 patients. The associated intracardiac procedures were performed in 10 patients. The follow-up period ranged from 2 months to 6 years. Operative mortality and late mortality after discharge was zero. The major postoperative complications included supraventricular tachycardia in one patient, oliguria and peritoneal dialysis in one and chest drainage (>30 ml/day) persisting >7 days in five (20%). One patient developed sinus bradycardia in association with sinus pauses 2 months after discharge. One patient developed pericardial effusion 1 month after discharge. A computational fluid dynamic study was performed in one patient. The computational fluid dynamic study showed that DCPC may have a better power efficiency.

CONCLUSIONS

Superior and inferior DCPCs to create a Fontan circulation in appropriately selected patients with functionally univentricular hearts can be performed with a low risk and a low rate of reinterventions. The midterm results are favourable.